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Interventions in Stroke and Stroke Management

World Stroke Day was celebrated on October 29th every year. It is considered a global awareness day established by World Stroke Organization (WSO). A global platform for the stroke community was evolved to create awareness and drive action on stroke across the World. Even the importance of World Stroke Day is discussed. The Webinar was conducted on ” World Stroke Day” discussing the topic “ Interventions in Stroke” in association with IRIA Kerala and JournoMed where the main motto of the Webinar is to “Save the Precious time during Stroke Management which saves many lives.” The event was conducted on 29th October 2022. 

Dr Sandeep Moudgil, a Neuroimaging and Interventional Neuroradiologist MD, DM, Assistant Professor of Neuroradiology from Government Medical College and Hospital, Chandigarh performed his research in neuroimaging and interventional neuroradiology, stroke, head and neck, spinal imaging, vascular and non-vascular interventions at a tertiary care level. He is actively involved in teaching residents. A young interventional radiologist with a promising career and he has taken a lead to train the younger generation of radiologists, especially in the cases of preventive radiology and clinical radiology. Certain subspecialties of Radiology need to be promoted and young radiologists have to adopt the leadership role in radiology. One crucial branch that needs to be focused on is “Interventional Radiology.” He spoke about “Interventions in Stroke.”

Dr Rijo Mathew, President of IRIA, Kerala explained the role of Preventive Radiology and Clinical Radiology which focuses on early imaging biomarkers for risk stratification in the larger context of preventive medicine and public health. It is very relevant in recent times and radiological imaging markers can be used to stratify the high-risk groups further on the modification of lifestyle or medical interventions or even interventional radiology can be significantly in demand that alters the course of disease that can be manifested at a later stage. 

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Dr Sandeep Moudgil also stressed many more things as per the diagnosis and the intervention. Neuro intervention plays a significant role as there was an instant response even though there is an enormous gap with relevant publications of Preventive Radiology. 

Dr Manisha Joshi, Consultant Interventional and Neuro Radiologist, in charge Department of Interventional Radiology, Rajagiri Hospital, Kochi spoke about the “Interventions in Stroke and Stroke Management.”

Stroke

  • The first recorded use of Stroke as a layman’s term was in 1599. The sudden onset of symptoms is attributed to a “stroke of god’s hand.” It was not adopted into the medical lexicon of the time and the physicians use the term “Apoplexy”, a diagnosis that had been in existence since the Hippocratic writings. 
  • It is impossible to cure a severe attack of apoplexy and difficult to cure a mild one. 
  • Hippocratic Aphorism 
  • Now, in recent times, brain stroke is treatable. Proper guidance and treatment for recovery need to be available. The patients need to act on time. 
  • At present, the main focus is on time i.e., World Stroke Day

Blood clots are the most common culprits of stroke. There is a lot of aetiology in the stroke i.e., atrial fibrillation, which can be dissection, arteriosclerosis, and vasculitis. There are a lot of other conditions which contribute to stroke aetiology. But double clot is the most common symptom observed. In earlier days, no treatments were available to deal with these blood clots. The aetiology varies in many cases and grasping good knowledge can make a difference in stroke management at present. The stent retriever is one of the tools which is available for stroke management and is connected to a wire permanently. There used to be detachable stents available in the earlier days. In recent times, all the non-detachable stents are available. It is used to push and pull the stent from the blood vessel and the catheter. This is an example of a small clot. 

Case Study 1

A 40-year male suffered from sudden left hemiplegia and in case study 2, a young female with acute symptoms are studied and left NCU tertiary infants. Here, in this case, aspiration thrombectomy is the procedure involved in this case. The aspiration is pulled over the clot using the catheter and the clot is pulled out with minimal trauma to the vessel and with an elegant technique. Although clots are of different varieties. Not every clot can be dealt with this technology. The aspiration pump tube is attached to the catheter which is going to the brain. Outside there is an aspiration tube; one can observe the blood around and clot passing through it. So, this is how a clot can be retrieved. A fresh acute clot can be retrieved within a matter of minutes. The patient’s health condition can be improved from day 1. The blocked MCA and after that one can observe the complete opening of MCA with a good feeling of ACA as well. The patient improved on day 1. Every patient can have on-table improvement based on the condition of the case and the severity of the case. The on-table improvement varies for every case. 

A common technique is Severe Stereognosis. It was a very good case in preventing the stroke. But if the patient doesn’t have good collateral, the patient undergoes Coronary Artery Bypass Surgery (CABG treatment). During the CABG, the blood pressure falls resulting in acute stroke. 

In patients who are undergoing Coronary Artery Bypass Surgery (CABG) many times, stenting is done. This is again the preventive part of the stroke treatment that the doctors follow. 

Dr Rijo Mathew delivered that on this World Stroke Day, discussion with the general public and making them aware regarding the importance of precious time i.e., the initiation of the golden hour or the minutes can significantly change the role of radiologists i.e., the interventional role of radiology. In clinical radiology, it significantly changes the consequences, and the course of the illness, and qualitatively brings back the patient’s life if the intervention is performed at the right point. So, the whole message of World Stroke Day is to make the patient aware of the symptoms of stroke and also to make use of this precious time to reach out to interventional radiology for the application of the procedures that have already been explained in the case-based scenario by Dr Manisha Joshi. 

Dr Sandip Modgil spoke about World Stroke Day and the Role of Interventional radiologists in Stroke Management and as well as in prevention. He spoke about patient management from in-house to hospital. In this case, social media plays a crucial role in bringing awareness regarding the inpatient facilities that are available at the hospitals. Even the government, private sector organizations, and NGOs play a role in spreading awareness regarding Stroke Management the second important thing is to note that the cases reach the table at the stipulated time. This is something that needs to be worked on all the time. There is a one-step approach for general practitioners, specialists, neurologists or general practitioners working in the field of medicine and working in the periphery. Whenever a patient reaches the emergency department, they should be sensitized. There can be a delay in detecting the strokes whether it is in-house or at the hospital and this can deteriorate the patient’s health condition. Train the general practitioners even if there are ophthalmologists regarding the treatment. At least start IVDBA drip and shift cut off a large number of strokes and time has to be managed accordingly. There are wonderful rules available online but need to be aware of and suspect the stroke. 

Conclusion 

The following are the guidelines that are required for treating the interventions of Stroke and Stroke Management. 

  • T stands for Team and Time. If the radiologist has seen a stroke, inform a resident, do the patient need to shift or drift for immediate patient recovery. 
  • Organize the institute whether it’s a government institute or a private institute. Paste a stroke checklist in almost every emergency room (ER) so that it helps in Stroke Management.  Cold Stroke can occur if things are not possible to a larger extent. 
  • Knowing, Knowledge and Connectivity regarding the interventions of stroke and stroke management are essential. 
  • E stands for Evaluate, analyze and evolve the things that need to be done during the evaluation process. 
  • Educate or spread awareness regarding the Interventions of Stroke and Stroke Management. This is the professional point of view practised at the tertiary level or the initial level centre.
  • From the Preventive Radiology point of view, these two experts, preventive radiology intends to focus on risk group stratification. Educate the high-risk groups that evolved. The symptoms that radiologists observe. The second level is motivation done by the general practitioners, general physicians and the doctors at the primary and the secondary levels of healthcare, who can detect the clinical symptoms, and the clinical examination findings and do not take much time and process them to the tertiary centres where the interventional procedures can be performed. This way the strokes can be managed to a major extent and thus resolving further issues leading to morbidity or mortality in most cases. 

 

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